Population Foundation of India, September 20, 2016
Members of Advisory Group on Community Action (AGCA) present
- Mr A R Nanda
- Dr H Sudarshan
- Dr Abhay Shukla
- Dr M Prakasamma
- Dr Thelma Narayan
- Ms Poonam Muttreja
Official of Ministry of Health and Family Welfare (MoHFW) present
- Ms Neha Aggarwal, Consultant, NHM
Officials of National Health Systems Resource Centre (NHSRC) present
- Dr Satish Kumar, Senior Advisor, Public Health Planning
- Mr Padam Khanna, Senior Consultant, Public Health Planning
- Dr Manoj Kumar Singh, Consultant, Public Health Planning
AGCA Secretariat Staff
- Mr Bijit Roy
- Mr Daman Ahuja
- Mr Smarajit Chakraborty
- Ms Seema Upadhyay
- Ms Jolly Jose
AGCA members who could not attend the meeting and were given leave of absence
- Dr Abhijit Das
- Dr Vijay Aruldas
- Mr Alok Mukhopadhyay
- Dr Narendra Gupta
- Dr Sharad Iyengar
- Ms Mirai Chatterjee
- Ms Indu Capoor
- Mr Gopi Gopalakrishnan
- Dr Saraswati Swain
Permanent invitees who could not attend the meeting and were given leave of absence
- Dr Sanjiv Kumar, Executive Director, NHSRC
- Dr Rajani Ved, Advisor, Community Processes, NHSRC
Ms Poonam Muttreja welcomed the participants to the 34th meeting of the Advisory Group on Community Action (AGCA).
The broad objectives of the meeting were to:
- Share updates on the ‘Strengthening Community Action for Health under the National Health Mission’ grant for the period June-September, 2016 and work priorities till December 2016.
- Discuss the AGCA future strategies.
- Deliberate on the outcomes of the AGCA sub-group meeting on Decentralised Participatory Health Planning and its operationalisation plan.
AGCA members confirmed the minutes of the 33rd AGCA meeting organised on June 3, 2016.
Compliance on Action Points from the 33rd AGCA meeting
Bijit Roy shared an update on the Action Taken on the 33rd AGCA meeting.
|Sl. No.||Action Points||Responsibility||Action Taken|
|1.||Prepare an analysis of the State PIPs – proposed budget by the states, approval from the MoHFW, and utilisation of resources for the community action for health component.||AGCA Secretariat||Analysis shared on August 2, 2016|
|2.||Organise the next AGCA sub-group meeting to discuss the modalities for initiating the process of decentralised participatory health planning in Karnataka, Rajasthan and Uttar Pradesh.||AGCA Secretariat and the NHSRC||Sub-group meeting organised on September 7, 2016
Meeting of minutes finalised and circulated among the sub-group members on September 16, 2016
Sub-group meeting organised to discuss the framework and tools on September 14, 2016
|3.||MoHFW can consider inviting the AGCA Secretariat to participate in the National Programme Coordination Committee (NPCC) meetings, when the CAH component is being discussed.||MoHFW||–|
|4.||Share inputs on the Terms of Reference (ToR) of the Common Review Mission (CRM) with the NHSRC.||AGCA Secretariat||Inputs shared with the NHSRC on September 7, 2016|
|5.||Share inputs/suggestions on the Patient Feedback System developed by the MoHFW.||AGCA Secretariat||Inputs of AGCA members included and shared along with the minutes of the 33rd AGCA meeting.|
Update on the Progress of AGCA Activities
Bijit Roy on behalf of the AGCA Secretariat presented an update on the ‘Strengthening Community Action for Health under the National Health Mission’ grant for the period June – September, 2016. The presentation included an overview of the state PIPs and approvals of the Record of Proceedings (RoPs) for the FY 2016-17, a briefing on the activities undertaken at the national and state levels as well as the work priorities for the next quarter October – December, 2016. A copy of the presentation is enclosed as Annexure A.
Bijit informed that the component ‘Community Action for Health (CAH)’ has been included by 24 states in their PIPs, including Nagaland for the first time. Out of the 24 states, 21 states have got approvals from the MoHFW as per their RoPs. Approvals have been kept pending for two states – Manipur and Jammu & Kashmir, while Rajasthan has been requested to share a detailed plan. In addition, there are substantial reductions in approvals in states such as Uttar Pradesh, Gujarat, Meghalaya, Delhi and Bihar. Overall, there has been a 48.6 per cent decrease in the approved amount, as compared to the FY 2015-16 approvals. Details of the state PIPs and RoP approvals are enclosed for reference as Annexure B.
The following points were made by the AGCA members:
- The AGCA and the NHSRC should plan a visit to Rajasthan to brief the State Mission Director NHM on reinitiating the CAH processes in the state.
- The MoHFW is currently looking at the utilisation trends of the resources allocated for each component. However, there are prolonged delays in their disbursement from the State NHM to the implementation organisations, which result in a low utilisation of funds. For example in Maharashtra, funds were disbursed to the State Nodal Organisation only in January 2016. The MoHFW could consider sending a directive to states advising a prompt disbursement of funds for the implementation of CAH activities.
- The AGCA Secretariat should organise bi-annual state level meetings to review progress on the approved CAH activities and the corresponding utilisation of funds.
- The AGCA Secretariat and the NHSRC should review and identify all the community process components (from FMR B1 to B15) and try to put them together in the next State PIP.
- The NHSRC organises periodic orientations for the newly inducted Principal Secretaries and State NHM Mission Directors. The AGCA could be invited to present and share their experiences on the CAH processes.
- Innovations on the CAH processes in the states should be documented and presented at the next National Innovations Summit.
- The Secretariat should organise a meeting with the NHSRC to discuss the RKS capacity building roll out plan.
- Dr Abhay Shukla shared that during the State Review in March 2016, it was decided that the process of reselection of the State Nodal NGO would be completed within 45 days. The state has so far shortlisted and interviewed five organisations in August 2016. However, no final decision has been taken. A further delay in the finalisation of the State Nodal NGO would affect the implementation of the approved activities. Dr Shukla requested the Secretariat to write a letter to the State NHM Mission Director to expedite a decision on this matter.
- The Secretariat informed that the Maharashtra State NHM officials have shared that the State Nodal NGO, SATHI, was given a no-cost extension letter by the State NHM two months ago. However, there has been no formal communication from SATHI and no plan either to meet the implementation of the approved activities till date. SATHI should consider sending a formal communication to the State NHM on the sanction of the no-cost extension. Subsequently, a letter could be sent by the AGCA Secretariat to expedite the selection process of the State Nodal NGO.
- The group suggested that the forthcoming regional consultations could be organised in Guwahati and Mumbai.
Screening of television spots on community action for health
Ms Muttreja shared that the AGCA Secretariat with support from Bombay Local Pictures has developed a set of 4 television spots on: i) Health Entitlements in Primary Health Centres (PHCs), ii) Health Entitlements in Sub-Health Centres (SHCs), iii) Services in Village Health and Nutrition Days (VHNDs), and iv) Role of Village Health, Sanitation and Nutrition Committees (VHSNCs). The spots have three versions – durations of 30 seconds, 60 seconds and a longer 3-minute version, which could be shared on social media and other digital platforms. She mentioned that the radio spots were being finalised and would be shared within the next three weeks. The spots were much appreciated by the group.
The following points were suggested by the AGCA Members:
- The AGCA Secretariat should develop a wider dissemination plan of the spots.
- The spots should be shared with the organisations which are implementing the CAH process and further disseminated in the field through WhatsApp groups.
- The spots could also be shared with health training, medical and academic institutions for a wider dissemination of the messages.
AGCA – Future Strategy
Ms Poonam Muttreja shared that the MoHFW had sought feedback from select AGCA members with regard to transferring the Secretariat of the AGCA to the NHSRC. Subsequently, she had spoken to senior MoHFW officials on the issue. The MoHFW had so far not taken a final decision on the issue. She intimated that the MoHFW is interested to seek feedback from AGCA members.
The following points were made by the AGCA members:
- The AGCA was constituted by an executive order of the MoHFW to function as an autonomous as well as a civil society group, which would provide guidance on the designing and implementation of the communitisation components under the National Rural Health Mission (NRHM). Members of the AGCA and representatives of NHSRC were of the unanimous view that spirit and objectives of the AGCA’s mandate would be best fulfilled if it were independent of day to day functions of policy and programmatic technical support, which are NHSRC’s mandate.
- The Terms of Reference (ToR) of the constitution of the AGCA vide government order number N.37014/3/2005-EAG, dated August 31, 20I5, mentions that the “The Population Foundation of India will provide the necessary Secretariat support to the Advisory Group, with suitable assistance from the Ministry of Health and Family Welfare”. A copy of the government order is enclosed for reference as Annexure C.
- The AGCA has been functioning as an independent think tank providing objective inputs and technical support to the national and state governments on the functioning of the NHM, especially from a community-centric perspective. The AGCA has also coordinated with various civil society actors to strengthen community action for health processes in across 22 states. The NHSRC, is perceived as an institution affiliated totally to the government for funding, reporting, technical assistance and its accountability lies with the government.
- The MoHFW located the AGCA Secretariat in PFI, which is a reputed national level institution and acceptable to the civil society players.
- The capacity building of members of the Village Health, Sanitation and Nutrition Committees (VHSNCs) and Rogi Kalyan Samitis (RKSs) to monitor and demand for quality services requires an intermediary organisation with specific skill sets. The AGCA has been playing this role in the state and hence support from the MoHFW should continue.
- Shifting of the AGCA Secretariat to NHSRC will impact the accountability aspects, which is the foundation for CAH.
- Over the last couple of years, the AGCA has been working closely with the NHSRC team on programmatic issues and specific initiatives, such as Decentralised Participatory Health Planning. In addition, the NHSRC representatives have been regularly participating in the AGCA meetings. The AGCA’s collaboration with the NHSRC on operational issues can be further discussed and strengthened.
- While, certain specific costs such as organising the AGCA Meetings, travel for members to the states can continue to be supported by the MoHFW, PFI should discuss and seek approval from its Governing Board for partial funding of the Secretariat. In addition, there is a need to leverage alternative sources of funding, beyond the government, for long term sustainability.
Update on the AGCA Sub-group Meeting on Decentralised Participatory Health Planning and Discussions on Operationalising the Process
Bijit Roy presented an ‘Update on Decentralised Participatory Health Planning Processes’. The presentation included the broad pre-requisites for implementation of the initiative and the roll out plan for the FY 2016-17, which will be initiated in Karnataka, Rajasthan and Uttar Pradesh and scaled-up to 14 districts in Maharashtra. A copy of the presentation is enclosed as Annexure D.
The fifth meeting of the Advisory Group on Community Action’s Sub-Committee on Decentralised Participatory Health Planning was organised on September 7, 2016 where in a sub-group consisting Ms Seema Upadhyay (AGCA Secretariat), Dr Manoj Kumar Singh (NHSRC) and Dr Nitin Jadhav (SATHI) has been constituted. The group will develop a briefer and tools on decentralised participatory health planning, which will be shared with the sub-committee members by October 3, 2016. A draft copy of the minutes of meeting is enclosed as Annexure E.
The following points were suggested by the group:
- The process cannot be viewed as a one-time activity. It needs to be allocated sufficient time and should be inclusive and participatory.
- The convergence with the Department of Panchayati Raj is essential, as it plays an important role in the planning process. Efforts should be made to involve the District Planning Committees in the process.
- The Secretariat has taken an initiative in Assam wherein discussions have been initiated with the State NHM and the State Institute of Rural Development (SIRD) to include participatory health planning in the Gram Panchayat Development Planning (GPDP) process.
- A separate line-item should be included in the State PIPs to identify, prioritise and approve proposals, which have emerged from the decentralised participatory planning process.
- All districts need to make an online submission of the PIPs from the current FY year, which will subsequently be locked. The changes to the District PIPs can be done by the designated nodal officer at the state level.
- The State Programme Managers (SPMs) and the District Programme Managers (DPMs) should be provided training on the decentralised participatory planning process and facilitate its inclusion in the District and State PIPs.
- The participatory planning process may be initiated in the model districts identified by the MoHFW. The list of model districts is enclosed as Annexure F.
- The State Advisory Group on Community Action (SAGCA) and the State Planning and Monitoring Committees (SPMCs) should review the proposals generated through the participatory planning process and facilitate its inclusion into the final State PIPs.
- AGCA Members suggested that the MoHFW and the NHSRC should insist the states to upload the district PIPs and approvals on their website.
- The NHSRC will coordinate with the State NHM teams to organise the state level orientations.
- The next sub- committee meeting will be organised on October 6, 2016.
Response from the NHSRC:
- The proposals will be uploaded as annexures in the district PIPs which cannot be removed or changed at the state level. Till last year, it was mandatory for the states to share the PIPs for the 186 High Priority Districts (HPDs) along with the SPIPs.
Action Points from the 34th AGCA Meeting
|Sl. No.||Action Points||Responsibility|
|1.||Organise a meeting with the MoHFW officials to share feedback of the AGCA members regarding transfer of the Secretariat.||AGCA Secretariat|
|2.||Share briefer and tools on decentralised participatory health planning with sub-group members prior to the next meeting planned on October 6, 2016.||AGCA Secretariat and NHSRC|
|3.||Coordinate with the State NHMs to organise orientations on decentralised participatory health planning in Karnataka, Rajasthan and Uttar Pradesh.||NHSRC|
|4.||Finalise and share the television and radio spots with the MoHFW.||AGCA Secretariat|
|5.||Organise a meeting with the NHSRC to discuss the RKS capacity building roll out plan.||AGCA Secretariat|
|6.||Invite AGCA to present and share experiences on the CAH processes during the orientation of new Principal Secretaries and Mission Directors, NHM.||NHSRC|